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Individual

MARIE MULLEN

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PT

Contact information

Practice address
4102 OGLETOWN STANTON RD, NEWARK, DE 19713-4183
(302) 894-1800
(302) 894-1811
Mailing address
790 REMINGTON BLVD, BOLINGBROOK, IL 60440-4909

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
J10001082
DE

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1000037719
DE
01
1610024
PABS
01
2287552000
AMERIHEALTH
01
5070-0012
CARE FIRST
01
76915007
NCA
Enumeration date
06/13/2006
Last updated
01/23/2012
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